Microvenous End-to-Side Anastomosis: An Experimental Study Comparing the Unilink System and Sutures

Abstract

A method for mechanical microvascular end-to-side anastomosis is presented and compared to conventional suture technique. Twenty rabbits had their facial veins divided from the jugular veins and reanastomosed end-to-side to the jugular veins, 2 cm cranially to the original bifurcation. The anastomoses were performed on one side of the neck with the Unilink system and on the other side with sutures. At sacrifice at two weeks (10 animals) and at 16 weeks (10 animals), all anastomoses were tested for patency and histologically evaluated. All 40 anastomoses were fully patent. The time required for completion of a mechanical anastomosis was on the average one-fourth the time required for suture anastomosis. No thrombus formation was noted in any of the specimens, but a slight narrowing because of intimal hyperplasia was noted in the recipient vessels in two mechanical anastomoses. It was demonstrated that mechanical anastomoses of small veins end-to-side can be performed in a rapid and safe manner with the Unilink system.

Modern adjuncts and technologies in microsurgery: An historical and evidence‐based review

“…While originally thought to be suitable for venous anastomoses only, their use now includes arterial anastomoses 36–40. Some series have also demonstrated the suitability of the coupler for use in end to side anastomoses 40, 41. Ring couplers have been shown to significantly reduce average anastomotic times and technical difficulty, effectively homogenizing results between senior and junior members of surgical teams,34, 36–39 and patency rates are generally reported as equal or superior to traditionally sutured anastomoses 36–39.…”

“…These studies have included well‐matched controlled trials, achieving level 2b evidence. Early reports questioned outcomes from ring couplers in irradiated fields, however more recent clinical,42 and animal,41 studies support its use in this setting.…”

Microanastomosis Venosa Mecánica Coupler®: Un Importante Aporte Tecnológico a La Microcirugía Vascular

“…Dentro de las investigaciones realizadas para implementar las suturas mecánicas en la práctica microquirúrgica, se logró evidenciar con estudios experimentales que estas nuevas suturas mecánicas vasculares presentan cambios hemodinámicos mínimos y semejantes a las anastomosis suturadas manualmente; además, cursan con un proceso de reparación similar al de los vasos suturados a mano, pudiendo inclusive llegar a mantener una fuerza de tensión mayor y más duradera [20][21][22][23][24][25] . Por otro lado, desde las primeras series clínicas publicadas en 1994 hasta la fecha, la incidencia de trombosis venosa publicada utilizando el Coupler ® es inferior al 3%, comparable a las técnicas tradicionales 9,26,27 .…”

The “Crater” Arteriotomy: A Technique Aiding Precise Intimal Apposition in End-to-side Microvascular Anastomosis

“…There are many different micro-arteriotomy techniques described, which can be broken down into 3 broad categories: (1) simple slit arteriotomies, creating a longitudinal or transverse cut in the vessel wall using a knife, 4 , 6 (2) “inside-out” arteriotomies performed with a “micropunch” to create a clean elliptical arteriotomy, as described by Hallock et al in an experimental study in the living rats, 4 , 7 (3) excision arteriotomies that involve excising from “outside-in” and for which several techniques have been described, such as circular arteriotomy. 4 In this article, we describe the “crater” technique, which is a type of “excision arteriotomy.”…”